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The Alphabet Soup of Care Delivery Transformation

Monday, September 10, 2012

There is widespread agreement that the current health care delivery system is fragmented. Your primary care physician may be the last to know what your cardiologist is doing, or your radiologist or pharmacist, for that matter. Though the providers may be well trained and supplying good care, they are part of a system that is less than efficient, a problem that could only get worse as the population ages and chronic conditions become more prevalent.

However, change is in the works. Both the private and public sectors are testing various care delivery transformation models to improve quality, reduce morbidity and mortality, and contain the costs of treatment. They range across the spectrum of group physician practices to fully-integrated health systems. The alphabet soup includes Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs) and other models. Some new approaches, such as pay-for-performance (P4P), use the traditional fee-for-service model and include incentives for improving quality of care. Others pay medical providers in new ways.

What is a patient-centered medical home? An accountable care organization? Which care coordination models is CMS supporting? Has the Innovation Center found any promising practices that may be scalable? Have these models shown a reduction in spending? Improvements in quality of care? How is improvement being measured?

To answer these important questions and related ones, the Alliance for Health Reform and WellPoint, Inc. sponsored a September 10 briefing. Speakers were: Randall Brown, Mathematica; Arnold Milstein, M.D., Stanford University; and Leeba Lessin, CareMore, which is known for innovation in coordinating care for seniors with chronic medical conditions. Ed Howard of the Alliance and Samuel Nussbaum, M.D., of WellPoint co-moderated.

The full panel listens as Arnie Milstein makes his presentation regarding cordinated care.

Leeba Lessin, president of CareMore Medical Enterprises, explained her private Medicare health plan's approach to managing costly, frail members at the Sept. 10 briefing cosponsored by WellPoint. (Photo by James Ryder.)

Arnold Milstein, MD, of Stanford University and director of the Stanford Clinical Excellence Research Center, discussed the challenges of moving toward a health care system that pays for better quality, and warned against adapting to local clinical norms at the Sept. 10 briefing cosponsored by WellPoint. (Photo by James Ryder.)

Randall Brown of Mathematica emphasized the need to focus on care coordination for people with chronic illness at the Sept. 10 briefing, The Alphabet Soup of Care Delivery Transformation, cosponsred by WellPoint. (Photo by James Ryder.)

Samuel Nussbaum, MD, of WellPoint, highlighted emerging relationships between insurers and medical providers at the Sept. 10 briefing cosponsored by WellPoint. (Photo by James Ryder.)

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